HBV Prevention for Homeless at Risk for HBV/HCV/HIV

描述（由申请人提供）：由于注射吸毒和无保护的性活动的高比率，无家可归的成年人感染B型肝炎病毒（HBV）、丙型肝炎病毒（HCV）和艾滋病毒的风险很高。我们的NIDA资助的RO 1奖使我们能够实施一项成功的干预措施，旨在评估对无家可归成年人进行HBV疫苗接种干预的有效性。我们的研究结果显示，与没有跟踪的标准计划相比，随机分配到护士案例管理加激励和跟踪组的无家可归成年人完成了HAV/HBV疫苗系列的百分比更高。最不可能完成疫苗接种的无家可归者是年轻人（<40岁），是男男性行为者（MSM）;这些年轻人中有相当多的人还报告使用甲基苯丙胺（MA）和可卡因/快克。兴奋剂（SA），包括MA和可卡因/快克是无家可归的男男性行为者常用的，他们与混乱的生活，失业和很少获得健康和社会服务作斗争;因此，HBV疫苗接种在这一人群中特别具有挑战性。HAV/HBV疫苗接种和有效的行为治疗是两个最重要的策略，以减少HBV感染的SA用户的这一风险群体。根据我们成功治疗使用SA的男同性恋和双性恋男性（GBM）的社区合作伙伴的建议，我们将把应急管理纳入我们的疫苗接种完成计划，该计划在年轻人和MSM中的完成率较低。因此，在这种竞争性的更新，我们提出了一个随机的，实验性的，两组设计，以评估护士病例管理计划的有效性，其中包括专业教育和应急管理和跟踪（NCCMT），与标准计划，包括简短的教育，应急管理和跟踪（SCMT）与500无家可归，年轻（18-39），SA使用GBM，完成TwinrixHAV/HBV疫苗，其次是降低肝炎和艾滋病毒的风险。这项研究是创新的，因为它将使我们能够看看一个增强的情况下管理和应急管理计划与标准的应急管理计划的效果。拟议的研究结合了接近、接触和干预隐藏和高危人群的最佳策略，以评估可能证明有利于预防HBV和HAV感染的干预措施的可行性和有效性。我们还将评估这些计划在完成HAV/HBV疫苗接种系列方面的相对成本。由于SA的使用可能会加剧无家可归者接触HAV和HBV的风险，特别是在可能尚未感染HBV的年轻使用者中，因此针对这一群体进行治疗的研究至关重要，直到他们得到适当的保护，免受HBV感染。 公共卫生相关性：在这项研究中，来自加州大学洛杉矶分校和朋友社区中心的研究人员将共同设计一个计划，以帮助年轻的无家可归的兴奋剂使用同性恋和双性恋无家可归的男子完成肝炎疫苗，并减少毒品和性活动。使用护士案例管理策略，发现成功与无家可归的成年人以及应急管理策略，发现成功与同性恋和双性恋无家可归的成年人由我们的社区合作伙伴，我们将评估一个计划，结合这两种策略的有效性。由于兴奋剂的使用有可能增加无家可归者接触甲型和B型肝炎病毒的风险，特别是在可能尚未感染HBV的年轻使用者中，这项研究的目标是让这一群体接受治疗，直到他们得到适当的保护，免受HBV感染，并希望降低丙型肝炎病毒和艾滋病毒的风险。

DESCRIPTION (provided by applicant): Homeless adults are at high risk for Hepatitis B virus (HBV), Hepatitis C virus (HCV) and HIV infection due to high rates of injection drug use and unprotected sexual activity. Our NIDA-funded RO1 award has enabled us to implement a successful intervention designed to evaluate the effectiveness of a HBV vaccination intervention with homeless adults. Our findings revealed that a greater percent of homeless adults randomized to the Nurse Case Managed Plus Incentive and Tracking group completed the HAV/HBV vaccine series compared to a Standard program without tracking. Homeless persons least likely to complete the vaccine series were young (<40), and were men having sex with men (MSM); a significant number of these young adults also reported methamphetamine (MA) and cocaine/crack use. Stimulants (SAs), including MA and cocaine/crack are commonly used by homeless MSM, who contend with disorganized lives, unemployment, and little access to health and social services; thus, HBV vaccination is particularly challenging in this population. HAV/HBV vaccination and effective behavioral treatment are two of the most important strategies for reducing HBV infection among this at-risk group of SA users. Based upon advice from our community partners who have successfully treated SA-using gay and bisexual men (GBM), we will incorporate contingency management into our vaccination completion program, which had lower completion rates among young adults and MSMs. Thus, in this competitive renewal, we propose a randomized, experimental, two-group design to evaluate the effectiveness of a Nurse Case Managed Program, which includes specialized education and Contingency Management and Tracking (NCCMT), with a Standard Program, including brief education, Contingency Management and Tracking (SCMT) with 500 homeless, young (18-39), SA-using GBM, on completion of theTwinrixHAV/HBV vaccine and, secondarily, on reduction of risk for hepatitis and HIV. This study is innovative in that it will allow us to look at the effect of an enhanced case management and contingency management program versus a standard contingency management program. The proposed study combines optimal strategies to approach, engage and intervene with a hidden and high- risk population to assess the feasibility and efficacy of interventions that may prove beneficial in preventing HBV and HAV infections. We will also assess the relative cost of these programs in terms of completion of the HAV/HBV vaccination series. As use of SAs threatens to intensify homeless persons' risk of exposure to HAV and HBV, particularly among young users who may not yet be HBV-infected, research targeted to engage this group in treatment, until they are suitably protected from HBV, is critical. PUBLIC HEALTH RELEVANCE: In this study, researchers from UCLA and Friends Community Center will work together in designing a program to assist young homeless stimulant-using gay and bisexual homeless men to complete the hepatitis vaccine and in reducing drug and sexual activity. Using nurse case management strategies, found successful with homeless adults as well as contingency management strategies, found successful with gay and bisexual homeless adults by our community partners, we will evaluate the effectiveness of a program that combines both strategies. As Stimulant use threatens to increase homeless persons' risk of exposure to hepatitis A and B viruses, particularly among young users who may not yet be HBV-infected, this research is targeted to engage this group in treatment, until they are suitably protected from HBV, and hopefully reduce risk for HCV and HIV as well.